Anaesthesia and Stress Response to Surgery

Open access

Anaesthesia and Stress Response to Surgery

The body reaction to surgery ranges from minor to massive both locally and generally. General response is in the form of widespread endocrinal, metabolic and biochemical reactions throughout the body. Neuro-endocrinal hormone system and inflammation mediators are involved and this process is called "stress response". The response has a compensatory mechanism and provides a maximum chance of survival because of increased cardio-vascular functions, fluid preservation and supply of increased demands for energy generating substrates. If the stress response is prolonged, it may result in exhaustion of essential components of the body, fatigue, decreased resistance, delayed ambulation and increased morbidity and mortality. Suppression of immune defense mechanisms has been demonstrated in the postoperative period. Such immune compromise can affect the postoperative infection rate, healing process, and the rate and size of tumour metastases disseminated during surgery. The mechanism of immunosuppression in the postoperative period is not fully understood. The known mediators of immune depression are neuroendocrine response as well as intravenous opioids and inhalational agents, which have shown to increase the susceptibility to infection through a significant cautions in choosing anaesthetic agents, to minimise harm to the patients. In this paper we review the data about the influence of different anaesthetic agents on neuroendocrine, immune and inflammatory response to surgical stress.

Antaa, R., Scheinin, M. (1993). Alpha2-adrenergic agents in anaesthesia. Acta. Anaesth. Scand., 37 1-16.

Absalom, A., Pledger, D., Kong, A. (1999). Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. Anaesthesia, 54 (9), 86-17.

Almawi, W. Y., Beyhum, H. N., Rahme, A. A., Rieder, M. J. (1996). Regulation of cytokine and cytokine receptor expression by glucocorticoids. J. Leukoc. Biol., 60, 563-572.

Bagry, H., de la Cuadra Fontaine, J. C., Asenjo, J. F., Bracco, D., Carli, F. (2008). Reg. Anest. Pain. Med., 33 (1), 17-23.

Beilin, B., Bessler, H., Papismedov, L., Weinstock, M., Shavit, Y. (2005). Continuous physostigmine combined with morphine-based patient-controlled analgesia in the postoperative period. Acta. Anaesth. Scand., 49, 78-84.

Beilin, B., Rusabrov, Y.,Shapira, Y., Roytblat, L.,Greemberg, L.,Yardeni, Y. Z., Bessler, H. (2007). Low-dose ketamine affects immune responses in humans during the early postoperative period. BJA, 99, 522-527.

Beilin, B., Shavit, Y., Dekeyser, F. G., Itzik, A., Weidenfeld, J. (2006). The involvement of glucocorticoids and interleukin-1 in the regulation of brain prostaglandin production in response to surgical stress. Neuroimmunomodulation, 13, 36-42

Beilin, B., Shavit, Y., Hart, J. (1996). Effects of anesthesia based on large versus small dose of fentanyl on natural killer cell cytotoxicity in the perioperative period. Anesth. Analg., 82, 492-497.

Bonnefont, J., Courade, J. P., Alloui, A., Eschalier, A. (2003). Mechanism of the antinociceptive effect of paracetamol., 63(2), 1-4.

Bowdle, A., Hines, R. (2002). Guest Editor Introduction: Pharmacology update 2002 Seminars in Anesthesia. Perioperative Medicine and Pain, 11, 247-257.

Brand J.-M., Frohn, C., Luhm, J., Kirchner, H., Schmucker, P. (2003). Early alterations in the number of circulating lymphocyte subpopulation and enhanced proinflammatory immune responce during opioid-based general anaesthesia. Shock, 20(3), 213-217.

Buyukkocak, U., Caglayan, O., Daphan, C., Aydinuraz, K., Saygun, O., Kaya, Agalar, F. (2006). Similar effects of general and spinal anaesthesia on perioperative stress response in patients undergoing haemorrhoidectomy mediators of inflammation. Croat. Med. J., 47(6), 862-868.

Buvanendran, A., Kroin, J. S., Berger, R. A., Hallab, N. J., Saha, C., Negrescu, C., Moric, M., Caicedo, M. S., Tuman, K. J. (2006). Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology, 104, 403-410.

Coderre, T. J., Katz, J., Vaccarino, A. L., Melzack. R (1993). Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain, 52, 259-285.

Crozier, T. A., Beck, D., Schlager, M., Wuttke, W., Kettler, D. (1987). Endocrinological changes following etomidate, midazolam or methohexital for minor surgery. Anesthesiology, 66, 628-635.

Crozier, T. A., Muller, J. E., Quitt, D. (1994). Effect of anaesthesia on the cytokine response to abdominal surgery. Brit. J. Anaesth., 72, 280-285.

Desborough, J. P. (2000). The stress response to trauma and surgery. Brit. J. Anaesth., 85(1), 109-117.

Desborough, J. P., Hall, G. M. (1989). Modification of the hormonal and metabolic response to surgery by narcotics and general anaesthesia. Clin. Anaesth., 3, 317-334.

Dossow, V., von, Baehr, N, Moshirzadeh. M., von Heymann, C., Braun, J. P., Hein, O. V., Sander, M., Wernecke, K., Konertz, W. C. (2006). Clonidine attenuated early proinflammatory response in T-cell subsets after cardiac surgery. Anesth. Analg., 103, 809-814.

Durlu, N., Batżslam, Y., özatamer, O. (2002). The effects of isoflurane and sevoflurane on immune system in minor surgical interventions. J. Anc. Med. School., 24(3), 105-112.

Duthie, D. J., Fraser, R., Nimmo, W. S. (1985). Effect of induction of anaesthesia with etomidate on corticosteroid synthesis in man. Brit. J. Anaest., 57(2), 156-159.

Ellis, J. E., Pedlow, S., Bains, J (2002). Premedication with clonidine does not attenuate suppression of certain lymphocyte subsets after surgery. Anaesth. Analg., 87, 1426-1430.

Hall, G. M., Peerbhoy, D., Shenkin, A. (2001). The relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses. Brit. J. Anaesth., 87, 537-542.

Hall, G. M., Salmon, P. (2002). Physiological and psychological influences on postoperative fatigue. Anesth. Analg., 95, 1446-1450.

Hollmann, M. W., Durieux, M. E. (2000). Local anesthetics and the inflammatory response: A new therapeutic indication? Anesthesiology, 93, 858-875.

Inada, T., Yamanouchi, Y., Jomura, S., Sakamoto, S., Takahashi, M., Kambara, T., Shingu, K. (2004). Effect of propofol and isoflurane anaesthesia on the immune response to surgery. Anaesthesia., 59(10), 954-959.

Jameson, P., Desborough, J. P., Bryant, A. E., Hall, G. M. (1997). The effect of cortisol suppression on the interleukin-6 and white cell responses to surgery. Acta. Anaesth. Scand., 40, 123-126.

Proud, G., Taylor, R. M. R. (1985). The influence of surgical operations on components of the human immune system. Brit. J. Surg., 72, 771-776.

Karabiyik, L., Sardas, S., Polat, U. (2001). Comparison of genotoxicity of sevoflurane and isoflurane in human lymphocytes studied in vivo using the comet assay. Mutat. Res., 492, 99-107.

Kehlet, H. (1998). Modification of responses to surgery by neural blockade: Clinical implications. In Cousins, M. J., Bridenbaugh, P. O. (eds.). Neural blockade in clinical anesthesia and management of pain (pp. 129-175). Philadelphia: JB Lippincott.

Kehlet, H. (2000). Manipulation of the metabolic response in clinical practice. World. J. Surg., 24(6), 690-695.

Lattermann, R., Carli, F., Wykes, L., Schricker, T. (2003). Perioperative glucose infusion and the catabolic response to surgery: The effect of epidural block. Anesth. Analg., 96, 555-562.

Lennard, T. W. J., Shenton, B. K., Borzotta, A., Donnelly, P. K., White, M., Gerrie, L. M., Marana, E., Annetta, M. G., Meo, F., Parpaglioni, R., Galeone, M., Maussier, M. L., Marana, R. (2003). Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery. Can. J. Anesth., 50(4), 348-354.

Masterson, G. R., Hunter, J. M. (1996). Does anaesthesia have long-term consequences? BJA, 77, 569-571.

Matsuoka, H., Kurosawa, S., Horinouchi, T. (2001). Inhalation anesthetics induce apoptosis in normal peripheral lymphocytes in vitro. Anesthesiology, 95, 1467-1472.

McMahon, S. B., Cafferty, W. B., Marchand, F. (2005). Immune and glial cell factors as pain mediators and modulators. Exp. Neurol., 192, 444-462.

Menigaux, C., Fletcher, D., Dupont, X., Guignard, B., Guirimand, F., Chauvin, M. (2000). The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth. Analg., 90,129-135.

Moller, I. W., Hjortso, E., Krantz, T., Wandall, E., Kehlet, H. (1984). The modifying effect of spinal anaesthesia on intra- and postoperative adrenocortical and hyperglycaemic response to surgery. Acta. Anaesth. Scand., 28, 266-269.

Moore, C. M., Desborough, J. P., Powell, H., Burrin, J. M., Hall, G. M. (1994). Effects of extradural anaesthesia on interleukin-6 and acute phase response to surgery. Brit. J. Anaesth., 72, 272-279.

Munck, A., Naray-Fejes-Toth, A. (1992). The ups and downs of glucocorticoid physiology. Permissive and suppressive effects revisited. Mol. Cell. Endocrinol., 90(1), C1-C4.

Naito, Y., Tamai, S., Shingu, K. (1992). Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology, 77(3), 426-431.

Norman, J. G., Fink, G. W. (1997). The effects of epidural anesthesia on the neuroendocrine response to major surgical stress: A randomized prospective trial. Amer. Surgeon., 63(1), 75-80.

Novak-Jankovic, V., Paver-Eržen, P., Bovill, J. G., Ihan, A. Osredkar, J. (2000). Effect of epidural and intravenous clonidine on the neuro-endocrine and immune stress response in patients undergoing lung surgery. Eur. J. Anaesth., 17, 50-56.

Procopio, M. A., Rassias, A. J., DeLeo, J. A., Pahl, J., Hildebrandt, L., Yeager, M. P. (2001). The in vivo effects of general and epidural anesthesia on human immune function. Anesth. Analg., 93, 460-465.

Romero-Sandoval, A., McCall, C., Eisenach J. C. (2005). A2-Adrenoceptor stimulation transforms immune responses in neuritis and blocks neuritis-induced pain. J. Neurosci., 25(39), 8988-8994.

Rosenberg, J., Kehlet, H. (1999). Does effective postoperative pain management influence surgical morbidity? Eur. Surg. Res., 31,133-137.

Samad, T. A., Moore, K. A., Sapirstein, A., Billet, S., Allchorne, A., Poole, S., Bonventre, J. V., Woolf, C. J. (2001). Interleukin-1 beta-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature, 410, 471-475.

Schneemilch, C. E., Band, U. (2001). Release of pro- and anti-inflammatory cytokines during different anesthesia procedures. Anaesthesiol. Reanim., 26, 4-10.

Schulze, S., Sommer, P., Bigler, D. (1992). Effect of combined prednisolone, epidural analgesia and indomethacin on the systemic response after colonic surgery. Arch. Surg., 127(3), 325-331.

Shavit, Y., Lewis, J. W., Terman, G. W. (1984). Opioid peptides mediate the suppressive effect of stress on natural killer cell activity. Science, 223, 188-190.

Sheeran, P., Hall, G. M. (1997). Cytokines in anaesthesia. Brit. J. Anaesth., 78, 201-219.

Tverskoy, M., Oren, M., Vaskovich, M., Dashkovsky, I., Kissin, I. (1996). Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism: A study in postoperative patients. Neurosci. Lett., 215, 5-8.

Wagner, R. L., White, P. (1984). Etomidate inhibits adrenocortical function in surgical patients. Anesthesiology, 61, 647-651.

Watkins, L. R., Maier, S. F. (2002). Beyond neurons: Evidence that immune and glial cells contribute to pathological pain states. Physiol. Rev., 82, 981-1011.

Watkins, L. R., Maier, S. F., Goehler, L. E. (1995). Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain, 63, 289-302.

Whelan, P., Morris, P. J. (1982). Immunological responces after transurethral resection of prostatae; general versus spinal anaesthetic. Clin. Exp. Immunol., 48, 611-618.

Wiegers, G. J., Reul, J. M. H. M. (1998). Induction of cytokine receptors by glucocorticoids: Functional and pathological significance. Tips, 19, 317-321.

Winkelstein, B. A., Rutkowski, M. D., Sweitzer, S. M., Pahl, J. L., DeLeo, J. A. (2001). Nerve injury proximal or distal to the DRG induces similar spinal glial activation and selective cytokine expression but differential behavioral responses to pharmacologic treatment. J. Comp. Neurol., 439, 127-139.

Woods, G. M., Griffits, D. M. (1988). Reversible inhibition of natural killer cell activity and lymphocyte subpopulation in patients undergoing hysterectomy. Brit. J. Anaesth., 60, 272-279.

Wu, C. T., Jao, S. W., Borel, C. O., Yeh, C. C., Li, C. Y., Lu, C. H., Wong, C. S. (2004). The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth. Analg., 99, 502-509.

Yardeni, I. Z., Beilin, B., Mayburd, E., Alcalay, Y., Bessler, H. (2008). Relationship between fentanyl dosage and immune function in the postoperative period. J. Opioid. Manag. 4(1), 27-33.

Yeager, M. P., Colacchio, T. A., Yu, C. T. (1995). Morphine inhibits spontaneous and cytokine-enhanced natural killer cell cytotoxicity in volunteers. Anesthesiology, 83, 500-508.

Yeager, M. P., Rassias, A. J., Fillinger, M. P., Discipio, A. W., Gloor, K. E., Gregory, J. A., Guyre, P. M. (2005). Cortisol antiinflammatory effects are maximal at postoperative plasma concentrations. Crit. Care. Med., 33(7), 1501-1507.

Journal Information

CiteScore 2017: 0.22

SCImago Journal Rank (SJR) 2017: 0.127
Source Normalized Impact per Paper (SNIP) 2017: 0.211


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 298 298 50
PDF Downloads 97 97 13